List Obat Kronis Bpjs

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no merk dagang generik harga bpjs harga rs izza prinsipal selisih

Human
1 ACTRAPID HM Bpha Human insulin Insulin
Short vial 10 ml Short
Acting 144763 -
Human
2 ACTRAPID HM PENFILL Bpha Human Insulin
insulin Short 100 UI/mL, 3mL Short
Acting 80502 -
3 Adalat Oros Bayr 20 mg tab oros 20 mg
Nifedipin 335 -
4 Adalat Oros Bayr 30 mg tab oros 30 mg
Nifedipin 37 -
5 Akarbose 100 Dexa tab 100 mg Akarbose 779 -
6 Akarbose 50 Dexa tab 50 mg Akarbose 562 -
7 Allopurinol 100 Mers tab 100 mg Alopurinol 99 165 HJ - 66
8 Amlodipin 10 Temp tab 10 mg Amlodipin 93 154 otto - 61
9 Amlodipin 5 Temp tab 5 mg Amlodipin 70 128 otto - 58
Analog
Apidra Solostar Aven inj 100 UI/ml, pen Insulin
10
@ 3ml Rapid
Acting 87 87 -
Atrovent HFA Boeh 20 mcg/puff inh 200 Ipratropium
11
dosis Bromida 866 -
Avodart 0.5 Gski Dutasterid Kap lunak
12
0,5 mg Dutasteride 47 -

13 Basaglar Bayr inj 100 UI/ml, pen @ 3ml Analog


Insulin
Long Acting 83.95 -
Berotec Boeh 100 mcg/puff inh 200 Fenoterol
14
dosis HBr 83.19 -
Berotec Solution Boeh 0,1% Boeh btl 50 Fenoterol
15
mL HBr 180.49 -
16 Betablok 100 Kalb Atenolol tab 100 mg
Atenolol 705 -
Perindoprila
17 Bioprexum Dava tab 5 mg
rginin 2.706 -
18 Bisoprolol 5 Nove tab 5 mg Bisoprolol 236 650 novell - 414
Bricasma Turbuhaler Asca 0,5 mg turbu
19
100 dosis Terbutalin 58.252 -
20 Bronsolvan 150 Kalb Teofilin tab 150 mg
Teofilin 295 -
Candesartan Cilexetil 16 Dexa 16 mg tab Kandesarta
21 novell - 625
16 mg n 898 1,523
Kandesarta
22 Candesartan Cilexetil 8 Dexa tab 8 mg
n 519 1,094 novell - 575
23 Captopril 12.5 Kifa tab scored 12,5 mg phapros - 27
Kaptopril 62 89
24 Captopril 25 Land tab scored 25 mg Kaptopril 75 94 phapros - 19
25 Clonidine Infa 0,15 mg IF - 30
Klonidin HCl 175 205
26 Clopidogrel 75 Dexa tab 75 mg
Klopidogrel 1318 1,020 phapros 298
27 Concor 1.25 Merc tab 1.25 mg Bisoprolol 1815 -
28 Concor 10 Merc tab 10 mg Bisoprolol 2.95 -
29 Concor 2.5 Merc tab 2,5 mg Bisoprolol 597 -
30 Decatona 30 Hars Fenitoin tab 30 mg
Fenitoin 183 -
31 Depakote Abbt 250 mg tab salut 250 mg
Valproat 1200 1,200
Depakote ER 250 Abbt Natrium Valproat
32
tab ER 250 mg Valproat 2954 -
Depakote ER 500 Abbt Natrium Valproat
33
tab 500 mg Valproat 5928 -
Deksametas
34 Dexamethasone 0.5 Noph tab 0,5 mg
berno - 59
on 32 91
35 Diamicron MR 60 Dava tab 60 mg Gliklazid 3.014 -
36 Digoksin 0.25 Yari tab 0,25 mg Digoksin 104 154 yari - 50
37 Diltiazem 30 Kifa tab 30 mg Diltiazem 133 182 IF - 49
38 Dopamet 250 Acta tab 250 mg Metildopa 946 2,057 act - 1,111

39 Ezelin Kalb Analog insulin long acting inj Analog


100 IU/mL, pen 3 mL insulin long
acting 83.95 -
40 Farnormin 50 Prat tab 50 mg 297 -
41 Fenitoin Ikap kaps 100 mg Fenitoin 158 -
Fenobarbita
42 Fenobarbital Kifa tab 30 mg kifa - 69
l 171 240
43 Furosemide 40 Kifa tab 40 mg Furosemid 77 127 SPH - 50
Glibenklami
44 Glibenklamide Infa 5 mg
d 119 -
45 Glicab Temp 80 mg Gliklazid 220 -
46 Glikuidon 30 Dexa tab 30 mg Glikuidon 1.075 -
47 Glimepiride 1 Dexa tab 1 mg Glimepirid 174 456 - 282
48 Glimepiride 2 Dexa tab 2 mg Glimepirid 207 520 - 313
49 Glimepiride 3 Dexa tab 3 mg Glimepirid 245 570 - 325
50 Glimepiride 4 Infa tab 4 mg Glimepirid 270 1,564 - 1,294
51 Glucotrol 10 mg Pfiz 10 mg Glipizide 3.4 -
52 Glucotrol 5 mg Pfiz 5 mg Glipizide 3.09 -
53 Haloperidol 5 Mers tab 5 mg -
Haloperidol 56 56
54 Haloperidol Yari 0,5 mg
Haloperidol 55 -
55 Haloperidol Yari 1,5 mg
Haloperidol 59 -
Harmida 2.5 Hars Glibenklamid tab 2.5 Glibenklami
56
mg d 180 -
57 Herbesser CD 100 Tana kap 100 mg Diltiazem 4.46 -
58 Herbesser CD 200 Tana kap 200 mg Diltiazem 4835 -
hidrokloroti
59 Hidroklorotiazid (HCT) 25 Kifa tab 25 mg
azid 155 -
Analog
60 Humalog Kwikpen Bayr Inj 100 UI/ml, Insulin
prefilled pen @ 3ml Rapid
Acting 87 87 -
Analog
61 Humalog Mix 25 Kwikpen Bayr Inj 100 Insulin Mix
UI/ml, prefilled pen @ 3ml
Acting 110.968 111 -
Analog
62 HUMALOG MIX 50 KWIKPEN Bayr Insulin Mix
prefilled, pen 3 mL
Acting 110.968 111 -
Human
Humulin R Kwikpen Bayr inj 100 UI/ml, Insulin
63
pen @ 3ml Short
Acting 80.502 -
Human
64 Humulin R Vial Bayr inj 100 UI/ml, vial Insulin
10 ml Short
Acting 144.763 -
Ibuprofen 100 mg/5mL Samp Susp
65
100mg/5 mL Ibuprofen 2.365 -
Ibuprofen 200 mg/5mL Temp Susp
66
200mg/5 mL Ibuprofen 4.465 -
67 Ibuprofen Noph tab 200 mg Ibuprofen 105 -
68 Ibuprofen Phyt tab 400 mg Ibuprofen 122 205 phapros - 83

69 Insulatard HM Bpha vial 10 ml, 100 Human


IU/mL Insulin
Long Acting 147.09 -

70 INSULATARD HM PENFILL Bpha Human Human


insulin intermediate catridge/penvil Insulin
Long Acting 76.875 -
71 Irbesartan Land 150 mg tab 150 mg
Irbesartan 400 -
72 Irbesartan Land 300 mg tab 300 mg
Irbesartan 720 -
73 Isoptin 240 Abbt tab 240 mg Verapamil 6.94 -
Issosorbid
74 Isosorbid Dinitrat 5 Yari tab 5 mg yari - 62
dinitrat 89 151
Kalsium Karbonat 500 SK2017 tab 500 Kalsium
75
mg Karbonat 417 917 calos - 500
76 Kaptopril 50 Infa tab 50 mg Kaptopril 124 224 IF - 100
Karbamaze
77 Karbamazepin 200 Mers tab 200 mg bamgetol - 1,750
pin 230 1,980
78 Kendaron 200 Dava tab 200 mg
Amiodaron 1.027 -
Klorpromazin Mers 100 mg tab sal 100 Klorpromazi
79 mersi - 348
mg n 147 495

80 Lantus Solostar Aven inj 100 UI/ml, pen Analog


@ 3ml Insulin
Long Acting 83.95 84 -

81 LEVEMIR FLEXPEN Beta 100 IU Analog


pen/flexpen, 3 mL Insulin
Long Acting 83.95 -
82 Lisinopril 10 Dexa tab 10 mg Lisinopril 259 -
83 Lisinopril 5 Nove tab 5 mg Lisinopril 209 -
84 Lodomer 2 Mers tab 2 mg
Haloperidol 84 -
85 Metformin 500 Temp tab 500 mg Metformin 96 182 HJ - 86
Metformin
86 Metformin 850 Temp tab 850 mg
HCl 150 -
Metilprednis
87 Metilprednisolon 16 Dexa Kap 16 mg novell - 519
olon 516 1,035
Metilprednis
88 Metilprednisolon 4 Mole tab 4 mg
olon 134 440 nulab - 306
89 Micardis Boeh 40 mg tab 40 mg
Telmisartan 3.045 -
90 Micardis Boeh 80 mg tab 80 mg
Telmisartan 5.409 -

91 Miniaspi Mers 80 mg tab 80 mg Asam


asetilsalisila
t (asetosal) 99 -
Human
Mixtard 30 HM BPha penfill 100 IU/mL,
92 Insulin Mix
3mL
Insulin 76.875 -
Human
MIXTARD 30 HM PENFILL Bpha Human
93 Insulin Mix
insulin mix catridge/penvil, 10 mL
Insulin 147.09 -
94 Molasma Mole 2,5 mg tab 2,5 mg Terbutalin 89 -
N-asetil
95 N-Asetil Sistein 200 Infa kaps 200 mg
nulab - 742
sistein 358 1,100
Natrium
96 Natrium diklofenak 25 Phap tab 25 mg
diklofenak 128 105 phapros
Natrium
97 Natrium diklofenak 50 Phap tab 50 mg
phapros
diklofenak 115 93
Gliseril
98 Nitral 0.5 Acta tab 0,5 mg
trinitrat 1.4 -
Gliseril
99 Nitrokaf Retard 2.5 Kifa tab 2,5 mg
kifa - 793
trinitrat 1560 2,353
Gliseril
100 Nitrokaf Retard Forte 5 Kifa tab 5 mg
trinitrat 2.402 -
Analog
NOVOMIX 30 FLEXPEN Bpha Mix Insulin
101 Insulin Mix
flexpen/catridge
Acting 110.968 -
Analog
102 NOVORAPID FLEXPEN Beta inj 100 Insulin
IU/ml, flexpen 3 mL Rapid
Acting 87 -
Obucort Swinghaler 200 dosis Otsu 200
103
mcg/puff Budesonid 103 -
Oscal 0.5 mcg Dank Kalsitriol tab 0.5
104 - 285
mcg Calcitriol 2850 3,135
Piridoksin
105 HCl
Piridoksin 10 Kifa Vitamin B6 tab 10 mg
(Vitamin
B6) 123 101 marin
106 Prednison Holi tab 5 mg Prednison 68 165 phapros - 97
107 Propranolol 10 Holi tab 10 mg
Propranolol 54 77 dexa - 23
Pulmicort Turbuhaler 100 dosis Asca 200
108
mcg/puff inh Budesonid 105.04 -
109 Ramipril 10 Nove tab 10 mg Ramipril 660 -
110 Ramipril 2.5 Dexa tab 2,5 mg Ramipril 295 -
111 Ramipril 5 Dexa tab 5 mg Ramipril 245 -
112 Retaphyl SR Kifa 300 mg tab SR 300 mg
Teofilin 1.123 -
113 Risperidon 1 Dexa tab 1 mg Risperidon 228 -
114 Risperidon 2 Dexa tab 2 mg Risperidon 273 -
115 Risperidon Dexa 3 mg tab 3 mg Risperidon 419 -
Salbulin 100mcg/dosis inhaler Imed 100
116
mcg/dosis Salbutamol 29.4 -
117 Salbutamol 4 Graf tab 4 mg kifa - 44
Salbutamol 70 114
118 Salbutamol Kifa 2 mg tab 2 mg
Salbutamol 63 151 graha - 88
Salbutamol Sirup Infa Sir 2 mg/5ml btl
119 IF - 1,054
100 ml Salbutamol 4446 5,500

120 SANSULIN LOG-G Sanb 100 IU Analog


pen/flexpen Insulin
Long Acting 83.95 -
Kombinasi:
Salmeterol
121 Seretide Diskus 100 Glax 100 mcg/puff 50 mcg;
inh 60 dosis Flutikason
propionat
100 mcg 103.817 -
Kombinasi:
Salmeterol
122 Seretide Diskus 250 Glax 250 mcg/puff 50 mcg;
inh 60 dosis Flutikason
propionat
250 mcg 116.687 -

Kombinasi:
Salmeterol
123 Seretide Diskus 500 Glax 500 mcg/puff 50 mcg +
Flutikason
Propionate
500 mcg 127.617 -
Kombinasi:
Salmeterol
124 Seretide Inhaler 50 Glax 50 mcg/puff 25 mcg;
Flutikason
propionat
50 mcg 55 -
125 Seroquel XR 200 Asca tab 200 mg
Quetiapine 14.3 -
126 Seroquel XR 300 Asca tab 300 mg
Quetiapine 15.548 -
127 Seroquel XR 400 Asca tab 400 mg
Quetiapine 18.616 -
128 Simvastatin 20 Temp tab 20 mg
Simvastatin 205 462 quantum - 257
129 Simvastatin Yari 10 mg tab 10 mg quantum - 88
Simvastatin 110 198
Spiriva 10s plus handihaler Boeh kaps
130
18 mcg Tiotropium 167 -
131 Spiriva Refill 30s Boeh kaps 18 mcg
Tiotropium 15.1 -
Spironolakt
132 Spironolacton Dexa 25 mg tab 25 mg otto - 170
on 195 365
133 Symbicort 120 dosis Asca 160/4.5mcg Kombinasi:
inh
Budesonide
Formoterol 139.88 -

134 Symbicort 60 dosis Asca 160/4.5mcg inh Kombinasi:


Budesonide
Formoterol 125.84 -

135 Symbicort 60 dosis Asca 80/4.5 mcg inh Kombinasi:


Budesonide
Formoterol 125.84 -
136 Tanapress 10 Tana tab 10 mg Imidapril 4.735 -
137 Tanapress 5 Tana tab 5 mg Imidapril 2.53 -

138 Thiamin (Vit B1) 50 Noph tab 50 mg Vitamin B1


(Thiamin
HCl) 85 -
Trifluopena
139 Trifluoperazin 5 mers tab 5 mg
zin 269 -
Triheksifeni
140 Triheksilfenidil 2 Mers tab 2 mg
dil 85 -
Valproat Sirup Mepr 250 mg/5 ml sir 250
141 otto - 21,611
mg/5 ml, btl 120 ml Valproat 15789 37,400
142 Valsartan 160 mg Eter tab 160 mg Valsartan 999 -
143 Valsartan Dexa tab 80 mg Valsartan 655 -
V-Bloc 6.25 Kalb Karvedilol Carvedilol
144
tab 6.25 mg Carvedilol 1.56 -
145 Verapamil 80 Kifa tab 80 mg Verapamil 314 -

146 Vitamin B 12 (Sianokobalamin) Mari tab Vitamin B12


50 mcg (Sianokobal
amin) 46 -

147 Vitamin B6 10 Kifa tab 10 mg Vitamin B6


(Piridoksin
HCl) 123 102 marin 21

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